Early infections in patients undergoing bone marrow or blood stem cell transplantation - a 7 year single centre investigation of 409 cases

Infections are a major cause of morbidity and mortality in patients undergo ing high-dose therapy and subsequent autologous or allogeneic haemopoietic stem cell transplantation, despite the change from topical to systemic anti -infection prophylaxis and the introduction of growth factors and new antim icrobial drugs. We report our single centre experience with data from 409 p atients treated at our unit from its opening in 1990 until May 1997, Three hundred and seventy-eight patients were transplanted for the first time, 12 patients were retransplanted or boosted and 19 patients were readmitted fo r miscellaneous reasons. 245 patients were allografted and 157 autografted, Antimicrobial prophylaxis was mainly quinolones, fluconazole plus amphoter icin-B orally, aciclovir, and TMP/SMX or pentamidine. Three hundred and nin eteen (78%) developed fever of significantly longer duration in the allogen eic setting with anti-CMV seropositivity, The most frequent infection was f ever of unknown origin (50.6%), followed by septicaemia (12.5%) and pneumon ia (11.0%). Pathogens isolated in 24.6% of the infections were mostly gramp ositive bacteria (57.9%), followed by non-fermenting rods (11.2%), Aspergil lus spp, and Candida spp, (10.3%, each), Cumulative response rate to antimi crobial therapy was 66.9%, Infections were responsible for 62.5% (25/40) of deaths after transplantation. Predominant pathogens were Aspergillus spp, (11), Candida spp, (four), and Pseudomonas spp, (three), None of the patien ts died from gram-positive bacterial infection. The risk of dying from infe ction was 11.2% after allografting and 0.8% after autotransplantation, Infe ctions remain a major risk for early death after allogeneic transplantation of haemopoietic stem cells, Infection with gram-negative bacteria can be p revented by quinolone prophylaxis. Predominant pathogens are Aspergillus sp p, Candida spp, and nonfermenting rods. Systemic infection with these patho gens is associated with a poor prognosis. Antimycotic prophylaxis and the t herapy must be improved.